Open Access Open Access  Restricted Access Subscription or Fee Access

Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

Vincent Wing-Ming Wong


Gestational diabetes mellitus (GDM) is a condition that affects the wellbeing of mother and fetus. Women with GDM are at risk of type 2 diabetes mellitus in the future, while fetal exposure to hyperglycaemia in-utero may affect their glycometabolic profile later in life. Appropriate screening and management of this problem is important in ensuring good pregnancy outcomes. In this review, the clinical implications, the various ways to screen and diagnose GDM, and management strategies during pregnancy will be discussed. For years, insulin is the mainstay of treatment if medical nutrition therapy fails to maintain adequate glycaemic control, but use of other oral pharmacotherapy may gain greater acceptance in the future. Following delivery, ongoing follow-up of these women is worthwhile as early intervention through lifestyle or pharmacotherapy may prevent the development of diabetes.


Gestational diabetes; Insulin therapy; Pregnancy outcomesrapy, pregnancy outcomes


Full Text:



Diagnosis and classification of diabetes mellitus. Diabetes Care 2012; 35 Suppl 1: S64-71;

Anna V, van der Ploeg HP, Cheung NW, et al. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care 2008; 31: 2288-93;

Dornhorst A, Paterson CM, Nicholls JS, et al. High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med 1992; 9: 820-5;

Hoffman L, Nolan C, Wilson JD, et al. Gestational diabetes mellitus--management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust 1998; 169: 93-7

Hod M, Yogev Y. Goals of metabolic management of gestational diabetes: is it all about the sugar? Diabetes Care 2007; 30 Suppl 2: S180-7;

Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for a common ground. Lancet 2009; 373: 1789-97;

Pedersen J. Diabetes and pregnancy: blood sugar of newborn infants [PhD thesis]. Copenhagen: Danish Science Press, 1952: 230

Langer O, Levy J, Brustman L, et al. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol 1989; 161: 646-53

Salvesen DR, Brudenell JM, Proudler AJ, et al. Fetal pancreatic beta-cell function in pregnancies complicated by maternal diabetes mellitus: relationship to fetal acidemia and macrosomia. Am J Obstet Gynecol 1993; 168: 1363-9

Balsells M, Garcia-Patterson A, Gich I, et al. Major congenital malformations in women with gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Res Rev 2012; 28: 252-7;

Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002;

Wendland EM, Torloni MR, Falavigna M, et al. Gestational diabetes and pregnancy outcomes – a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12: 23;

Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag 2009; 5: 153-64;

Girz BA, Divon MY, Merkatz IR. Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes. J Perinatol 1992; 12: 229-33

ADA. Position Statement: Gestational Diabetes Mellitus. Diabetes Care 2004; 27(Supp1): S88-90;

Agarwal MM, Hughes PF, Punnose J, et al. Fasting plasma glucose as a screening test for gestational diabetes in a multi-ethnic, high-risk population. Diabet Med 2000; 17: 720-6;

Wong VW, Garden F, Jalaludin B. Hyperglycaemia following glucose challenge test during pregnancy: when can a screening test become diagnostic? Diabetes Res Clin Pract 2009; 83: 394-6;

van Leeuwen M, Louwerse MD, Opmeer BC, et al. Glucose challenge test for detecting gestational diabetes mellitus: a systematic review. BJOG 2012; 119: 393-401;

Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477-86;

Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339-48;

Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340: c1395;

Kerbel D, Glazier R, Holzapfel S, et al. Adverse effects of screening for gestational diabetes: a prospective cohort study in Toronto, Canada. J Med Screen 1997; 4: 128-32

Katon JG, Russo J, Gavin AR, et al. Diabetes and depression in pregnancy: is there an association? J Womens Health (Larchmt) 2011; 20: 983-9;

Byrn MA, Penckofer S. Antenatal depression and gestational diabetes: A Review of Maternal and Fetal Outcomes. Nurs Womens Health 2013; 17: 22-33;

Schaefer-Graf UM, Kjos SL, Fauzan OH, et al. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care 2004; 27: 297-302;

Kurishita M, Nakashima K, Kozu H. Glycated hemoglobin of fractionated erythrocytes, glycated albumin, and plasma fructosamine during pregnancy. Am J Obstet Gynecol 1992; 167: 1372-8

Inkster ME, Fahey TP, Donnan PT, et al. The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes. Acta Obstet Gynecol Scand 2009; 88: 1153-7;

Cocilovo G, Guerra S, Colla F, et al. Glycosylated hemoglobin (HbA1) assay as a test for detection and surveillance of gestational diabetes. A reappraisal. Diabete Metab 1987; 13: 426-30

Lowe LP, Metzger BE, Dyer AR, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care 2012; 35: 574-80;

Reader D, Splett P, Gunderson EP. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc 2006; 106: 1426-33;

Moses RG, Luebcke M, Davis WS, et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr 2006; 84: 807-12

Moses RG, Barker M, Winter M, et al. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 2009; 32: 996-1000;

Major CA, Henry MJ, De Veciana M, et al. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998; 91: 600-4;

Jovanovic-Peterson L, Durak EP, Peterson CM. Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Am J Obstet Gynecol 1989; 161: 415-9

Brankston GN, Mitchell BF, Ryan EA, et al. Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol 2004; 190: 188-93;

Institute Of Medicine. Weight gain during pregnancy: reexamining the guidelines. National Academy Press. 2009

Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol 2011; 51: 432-6;

Wong VW. Gestational diabetes mellitus in five ethnic groups: a comparison of their clinical characteristics. Diabet Med 2012; 29: 366-71;

Nachum Z, Ben-Shlomo I, Weiner E, et al. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial. BMJ 1999; 319: 1223-7;

Aydin Y, Berker D, Direktor N, et al. Is insulin lispro safe in pregnant women: Does it cause any adverse outcomes on infants or mothers? Diabetes Res Clin Pract 2008; 80: 444-8;

Hod M, Damm P, Kaaja R, et al. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am J Obstet Gynecol 2008; 198: 186 e1-7

Pettitt DJ, Ospina P, Howard C, et al. Efficacy, safety and lack of immunogenicity of insulin aspart compared with regular human insulin for women with gestational diabetes mellitus. Diabet Med 2007; 24: 1129-35;

Wyatt JW, Frias JL, Hoyme HE, et al. Congenital anomaly rate in offspring of mothers with diabetes treated with insulin lispro during pregnancy. Diabet Med 2005; 22: 803-7;

Callesen NF, Damm J, Mathiesen JM, et al. Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. J Matern Fetal Neonatal Med 2013; 26: 588-92;

Lepercq J, Lin J, Hall GC, et al. Meta-Analysis of Maternal and Neonatal Outcomes Associated with the Use of Insulin Glargine versus NPH Insulin during Pregnancy. Obstet Gynecol Int 2012; 2012: 649070;

Mathiesen ER, Hod M, Ivanisevic M, et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care 2012; 35: 2012-7;

Dhulkotia JS, Ola B, Fraser R, et al. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 2010; 203: 457 e1-9;

Coetzee EJ, Jackson WP. Metformin in management of pregnant insulin-independent diabetics. Diabetologia 1979; 16: 241-5;

Coetzee EJ, Jackson WP. Pregnancy in established non-insulin-dependent diabetics. A five-and-a-half year study at Groote Schuur Hospital. S Afr Med J 1980; 58: 795-802

Rowan JA, Hague WM, Gao W, et al. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358: 2003-15;

Hague WM, Davoren PM, McIntyre D, et al. Metformin crosses the placenta: a modulator for fetal insulin resistance? BMJ 2003; 327: 880-1

Rowan JA, Rush EC, Obolonkin V, et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011; 34: 2279-84;

Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343: 1134-8;

Elliott BD, Langer O, Schenker S, et al. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol 1991; 165: 807-12

Nicholson W, Bolen S, Witkop CT, et al. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009; 113: 193-205

Conway DL. Obstetric management in gestational diabetes. Diabetes Care 2007; 30 Suppl 2: S175-9;

Witkop CT, Neale D, Wilson LM, et al. Active compared with expectant delivery management in women with gestational diabetes: a systematic review. Obstet Gynecol 2009; 113: 206-17


  • There are currently no refbacks.

© SEEd srl